Fatty Liver Disease: Why It Is Often Silent, What Tests Show and What Helps

What it involves

MedlinePlus defines nonalcoholic fatty liver disease as a buildup of fat in the liver that is not caused by heavy drinking. It is usually, but not always, related to being overweight. Many people have no symptoms, though a more severe form called NASH can lead to scarring of the liver.

Who this is for

• Patients told that a liver enzyme on routine blood work was higher than normal
• Patients with prediabetes, diabetes, high cholesterol, or high blood pressure who want to know about liver risk
• Patients carrying extra weight who want a plan that protects the liver as well as the heart
• Patients with a fatty liver on a scan done elsewhere who need a primary care follow-up

What to expect

• Questions about weight, alcohol, medicines, supplements, and family history of liver or metabolic disease
• A look at prior lab results and a conversation about which blood tests to repeat
• A discussion of blood sugar, cholesterol, and blood pressure, which tend to travel with a fatty liver
• A plan that may include lifestyle steps, follow-up blood work, or a referral for imaging or a liver specialist

Why fat collects in the liver

MedlinePlus lists the factors that raise the risk. Being overweight or obese comes first, and the more extra weight, the higher the risk. Prediabetes and insulin resistance, type 2 diabetes, high cholesterol, high triglycerides, and high blood pressure follow. Rapid weight loss, a poor diet, lack of exercise, and some medicines also appear, and some people have the condition with no known risk factor at all.

Usually no symptoms

MedlinePlus says most people with a fatty liver do not feel anything. When symptoms do appear, tiredness and pain in the upper right belly are the most common. In people with cirrhosis from NASH, it lists weakness, loss of appetite, nausea, itching, yellow skin or eyes, swelling of the legs and abdomen, and confusion. Ongoing tiredness has its own page, the fatigue guide.

How it is found

MedlinePlus says it is often discovered through routine blood tests that show how well the liver is working. The liver function tests guide explains the enzymes on that panel. A provider may then order an ultrasound to confirm, or a scan, a stiffness test called elastography, or sometimes a biopsy. Those imaging steps are done at outside facilities, which this practice would arrange.

The link to heart and blood sugar numbers

Because a fatty liver tends to appear alongside prediabetes, diabetes, cholesterol and blood pressure problems, the same visit often reviews them together. The prediabetes A1c guide, high cholesterol management, and hypertension management pages explain what each of those follow-ups involves.

What MedlinePlus says helps

MedlinePlus says losing weight and managing diabetes can slow or sometimes reverse fat deposits in the liver. It lists a healthy low-salt diet, regular activity, avoiding alcohol, treating cholesterol, triglycerides and high blood pressure, taking medicines as directed, and getting vaccinated against hepatitis A and B. For more severe disease with scarring, it mentions a recently approved medicine that a specialist would decide on.

Telling your provider what you take

MedlinePlus advises talking to a provider about every medicine you use, including herbs, supplements, and over-the-counter products, because some can affect the liver. Bring the bottles or a list to the visit, which makes the review faster and more accurate.

The outlook

MedlinePlus says many people with a fatty liver never develop NASH and have no health problems, and that healthy habits can help prevent more serious damage. It also says it is unclear why some people progress, which is why follow-up matters. Weight changes are covered in the obesity and BMI guide.

Sources

• MedlinePlus — Nonalcoholic fatty liver disease
• MedlinePlus — Steatotic Liver Disease